SOME REMARKS ON CHRONIC CONDITIONS.

BY H. MCHATTON, M.D., MACON.

It seems that in the wonderful advance of medical science in all its departments in the last few years, that there is one class of disease in which the patients are not getting the full benefit that they should derive. This large number of afflicted can be classed among the chronic and subacute types of diseases. Many of these can be cured. Many can be rendered comfortable for an average lifetime, and all can be ameliorated and rendered more comfortable for varying periods of time by proper medical supervision, which they do not get, simply because a diagnosis is not made early enough in their

cases.

This lack of early diagnosis in these serious conditions is due to both parties-the patient and the physician. On the part of the patient, we have the American craze for patent medicines, for specialists and for home-made diagnosis.

These unfortunates of the least intelligent class have a diagnosis and remedy for every conceivable type of sickness, and only send for a physician after the so-called home remedies have been exhausted.

The more intelligent have a series of specialists whom they consider responsible for the various organs of their body. But who is responsible for the man himself in the altogether, as DuMaurier would describe it? No one.

He has as a rule no family physician, when we all know that he should have not only one, but two. His regular family physician, who, if worthy of the trust, should be absolutely familiar with his physical condition, and any defect that he may have, also a second choice for emergencies, who should be posted as to any existing chronic disease.

When we are called to a new family where we have any reason to presume that we will be the family physician for even a short space of time, it is our duty not only to prescribe for any slight, transient ailment that may exist, but at the earliest possible opportunity to make a complete examination of every member of the family, so as to be able to give them more efficient service in the future. This can be done as a rule without exciting comment. When we find a patient in bed, a good examination may be obtained of the heart, lungs and abdominal organs, and the request for a specimen of urine excites no comment in these days. Then think of our position when we are called in an emergency and know that there is no pre-existing organic lesion.

We may not live to see it, but the time will come when all sensible people will go to a physician once or twice a year for a complete physical examination. They go to the dentist with regularity to have their teeth examined the condition of our heart, lungs and kidneys are certainly of more vital importance than the condition of our teeth.

Just think for a moment what the result would be if all of our patients were to have a complete physical examination once a year, with our present capacity for accurate and early diagnosis. In tuberculosis alone, the saving of life would be too vast to contemplate. We know that when the diagnosis is usually made, the large majority

of these unfortunates are incurable and at the same time, some of our best authorities place the recoveries of the incipient cases under proper treatment as high as ninety per cent.

In infancy and early childhood, think of the immense number of cases of marasmus, rickets, tubercular joint diseases, and under the modern methods of feeding— scurvy, that either kill or handicap for life, that are not cured, because they are only seen after the damage has become irremediable.

At puberty, the army, especially of girls, where proper medical supervision as to hygiene, school work, etc., for a year or so, means the difference between a healthy future life or the nervous and physical wrecks that one sees every day-a curse to themselves and everybody that they come. in contact with. When we come to adult life, middle life and old age, the amount of benefit that is to be obtained by an accurate knowledge and proper attention to our physical condition is too vast to be taken in detail.

Take the two most common, chronic, incurable lesions: certain types of heart and kidney diseases. We all know that taken early and given proper attention, life is often prolonged indefinitely. No one can tell how long a given case may live a life of absolute comfort.

At present, I have a patient who has had a chronic cirrhotic kidney for over fifteen years. Another died last winter from an intercurrent pneumonia, who had been under observation for about eighteen years. Another who had been carried through several attacks of impending uremia, in the course of years, moved his business to an adjoining city. I insisted on giving him a letter to a physician and emphasized the importance of immediately putting himself under his care. A few months later, his

death was announced from congestion, and my letter was found among his effects.

About twelve years ago, I saw for a transient condition, a schoolboy who had an enlarged heart with mitral lesion. He was under my care for about ten years. At the end of that time, if there was any material change in his heart, it was not discernible. He moved to another city, and did not recognize that going up and down several flights of stairs twenty or thirty times a day was violent exercise. In two months he returned home with a dilated heart and died after being bedridden for six months.

A few days since I saw in consultation a frail young woman whose heart had never been examined, but who gave a history of slight cardiac damage. Her father was taken sick, and she insisted on nursing him. On trying to lift him, she was taken with a violent pain in the left side and lived two days. Diagnosis: Dilated heart.

Suppose she had been warned of her condition! How often do we hear of an intimate friend or a patient who has been refused life insurance for some organic lesion that should have been discovered and treated years ago. How often do we find that some patient who comes to consult us for some supposed trivial ailment is really in an advanced stage of a chronic disease.

We hardly ever attend a medical meeting that some of our brother specialists do not read us a paper on "What the General Practitioner Should Know About So and So," with a laudable intention of putting the general practitioner in a position of making an early and accurate diagnosis of the disease in question.

Do any of you recall ever having heard anything in regard to what the specialist should know about general medicine?

We realize that the experience of an individual is but

a drop of water in the ocean of knowledge, but a drop is something in my opinion, in the existing status of the profession. Where there is one error of omission that is of material detriment to the patient committed by the general practitioner, there are ten committed by the specialist. The fault lies, first, with his patients, and, second, in the lack of a proper degree of appreciation by the specialist and the general practitioner of the inestimable value to the patient of their conjoined service.

A few years ago, it was unusual for a patient to go to a specialist excepting through the advice of his physician. The specialists of that time were men who had carefully worked themselves into special lines and had a just appreciation from early training of the value of the knowledge of the general condition of the patient and its bearing on the treatment and prognosis of the given case.

Gradually young men began to go directly into special lines of work with no practical knowledge of general medicine. At the same time, the public became vaccinated with the idea that if they had a symptom referable to any organ or region of the body presided over by a specialist, it was simply a loss of time, and, incidentally, dollars, not to go to headquarters at once and get the best, which was a rational line of reasoning from their standpoint.

If you will excuse slang, right here trouble began, which has increased ever since. The patient began to lose the full benefit which he should derive from modern medicine, which he will continue to lose until there is more accord and interchange of views for his benefit between the specialist and the general practitioner. This is an existing condition in the profession to-day. None of us can deny the fact. It has gradually crept in year by year; virtually no one is to blame. Still the innocent patient is surely the victim.